Table5_Efficacy and Safety of Qingfei Paidu Decoction for Treating COVID-19: A Systematic Review and Meta-Analysis.docx

Background: Qingfei Paidu decoction (QFPD) has been widely used in treating COVID-19 in China. However, there is still a lack of comprehensive and systematic evidence to demonstrate the effectiveness and safety of QFPD. This study aims to evaluate the efficacy and safety of QFPD in patients with COVID-19.
Methods: We searched seven databases up to 5 March 2021. Two reviewers independently screened studies, extracted data of interest, and assessed risk of bias. The Cochrane risk of bias tool was used to assess the risk of bias of randomized controlled trials. The Newcastle–Ottawa scale was used to assess the risk of bias of cohort and non-randomized trials. The “Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group” was adopted for controlled pre–post studies. We used the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) to assess the certainty of evidence. We carried out a random effect meta-analysis using RevMan 5.3. For outcomes that could not be meta-analyzed, we performed a descriptive analysis.
Results: We identified 16 studies with 11,237 patients, including one RCT, six non-randomized trials, two cohort studies, and seven pre–post studies. The certainty of evidence was low to very low because of the observational study design. QFPD combined with conventional treatment might decrease the time for nucleic acid conversion (MD = −4.78 days, 95% CI: −5.79 to −3.77), shorten the length of hospital stay (MD = −7.95 days, 95% CI: −14.66 to −1.24), shorten the duration of symptoms recovery of fever (MD = −1.51 days, 95% CI: −1.92 to −1.09), cough (MD = −1.64 days, 95% CI: −1.91 to −1.36) and chest CT (MD = −2.23 days, 95% CI: −2.46 to −2.00), improve the overall traditional Chinese medicine symptom scores (MD = 41.58 scores, 95% CI: 32.67 to 50.49), and change the laboratory indexes, such as WBC, AST, and CRP.
Conclusion: QFPD combined with conventional treatment might be effective for patients with COVID-19. No serious adverse reactions related to QFPD were observed. Further high-quality studies are still needed in the future.

背景：清肺排毒汤（Qingfei Paidu decoction, QFPD）在我国已被广泛用于新型冠状病毒肺炎（COVID-19）的治疗，但目前仍缺乏全面且系统的证据以证实其有效性与安全性。本研究旨在评估清肺排毒汤用于新型冠状病毒肺炎患者的疗效与安全性。
方法：本研究检索截至2021年3月5日的7个数据库。由2名评价者独立筛选研究、提取目标数据并评价偏倚风险。采用Cochrane偏倚风险工具评价随机对照试验（randomized controlled trial, RCT）的偏倚风险，使用纽卡斯尔-渥太华量表评价队列研究与非随机试验的偏倚风险，针对有对照的前后研究则采用"Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group"进行质量评估。本研究采用建议、评估、发展和评价分级（Grading of Recommendations, Assessment, Development, and Evaluations, GRADE）体系评价证据确定性。使用RevMan 5.3软件开展随机效应Meta分析，对于无法进行Meta分析的结局指标，则进行描述性分析。
结果：本研究共纳入16项研究，涉及11237例患者，其中包括1项随机对照试验、6项非随机试验、2项队列研究以及7项前后研究。由于纳入研究多为观察性研究设计，证据确定性为低至极低水平。相较于单纯常规治疗，联合清肺排毒汤可缩短核酸转阴时间（均数差=-4.78天，95%置信区间：-5.79~-3.77）、缩短住院时长（均数差=-7.95天，95%置信区间：-14.66~-1.24）、缩短发热症状恢复时间（均数差=-1.51天，95%置信区间：-1.92~-1.09）、咳嗽症状恢复时间（均数差=-1.64天，95%置信区间：-1.91~-1.36）及胸部CT影像学异常恢复时间（均数差=-2.23天，95%置信区间：-2.46~-2.00），提升中医症状总评分（均数差=41.58分，95%置信区间：32.67~50.49），并可改善白细胞（white blood cell, WBC）、天门冬氨酸氨基转移酶（aspartate aminotransferase, AST）、C反应蛋白（C-reactive protein, CRP）等实验室指标。
结论：清肺排毒汤联合常规治疗对新型冠状病毒肺炎患者可能具有临床获益，未观察到与清肺排毒汤相关的严重不良反应。未来仍需开展更多高质量研究以进一步验证其疗效与安全性。